Deep flexor sarcopenia as a predictor of poor functional outcome after anterior cervical discectomy in patients with myelopathy

Thakar, Sumit; Arun, Aditya Atal; Aryan, Saritha; Mohan, Dilip; Hegde, Alangar S.

doi:10.1007/s00701-019-03972-8

Cited by 8 publications

(8 citation statements)

References 42 publications

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“…According to our search, eleven studies were found, four of which were prospective and seven retrospective. Six studies were concentrated on anterior approaches (Table 1 [19][20][21][22][23]) and five studies on posterior approaches in the cervical spine (Table 2 [24][25][26][27][28][29]).…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, functionality expressed by Nurick scores was significantly correlated to deep flexors areas as well as the ratio of deep flexors to deep extensors areas in anterior approaches only in one study [ 22 ]. In posterior approaches, the preservation of posterior paraspinal muscles by applying new techniques demanding less muscle manipulation could lead to improved functionality and reduced pain scores [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…In continuation of his research background, Thakar et al (2019) prospectively studied 45 patients with single-level ra-Siasios et al J Clin Med Res. 2021;13(7):367-376 diculopathy (myelopathy or myelopathy) that underwent an anterior cervical discectomy (ACD) procedure [22]. The main goal was to record all the possible predictors of the surgical outcome, as stated from the literature, and to study their significance.…”

Section: Anterior Approachesmentioning

confidence: 99%

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The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

et al. 2021

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Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient's functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient's postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expres-sion. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Anterior Approachesmentioning

confidence: 99%

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The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

et al. 2021

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“…We previously demonstrated that increased demyelination (lower magnetization transfer ratios (MTR)) in anterior and lateral cord regions and descending motor tracts such as corticospinal, reticulospinal tracts are associated with poor functional recovery after surgery [ 64 ]. Sarcopenia in deep cervical flexors (LC) has been shown to predict poor post-surgical improvement in clinical function in patients with myelopathy [ 65 ]. In this study, our preliminary analysis evaluating MFI and post-surgical functional recovery showed that increased pre-surgical MFI in LC muscles is adversely related to post-surgical improvement in clinical scores of mJOA and Nurick.…”

Section: Discussionmentioning

confidence: 99%

Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model

et al. 2021

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Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.

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“…Spinal cord segmentation analysis using qMRI imaging data of patients by tools such as the Spinal Cord Toolbox (SCT) [ 13 ] has recently been shown to provide improved predictive power [ 14 ], but these tools tend to break down when analyzing damaged spinal cords [ 15 ]. Studies which did find success in predicting myelopathic outcomes opted instead to manually inspect the spinal cord [ 4 , 16 ] or manually correct the output of automated analyses [ 17 ], reducing the benefits these automated processes provide. To optimize their use, it is imperative to evaluate the extent and source of these limitations.…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Morphology in Degenerative Cervical Myelopathy Patients; Assessing Key Morphological Characteristics Using Machine Vision Tools

Ost

Jacobs

Evaniew

et al. 2021

JCM

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Despite Degenerative Cervical Myelopathy (DCM) being the most common form of spinal cord injury, effective methods to evaluate patients for its presence and severity are only starting to appear. Evaluation of patient images, while fast, is often unreliable; the pathology of DCM is complex, and clinicians often have difficulty predicting patient prognosis. Automated tools, such as the Spinal Cord Toolbox (SCT), show promise, but remain in the early stages of development. To evaluate the current state of an SCT automated process, we applied it to MR imaging records from 328 DCM patients, using the modified Japanese Orthopedic Associate scale as a measure of DCM severity. We found that the metrics extracted from these automated methods are insufficient to reliably predict disease severity. Such automated processes showed potential, however, by highlighting trends and barriers which future analyses could, with time, overcome. This, paired with findings from other studies with similar processes, suggests that additional non-imaging metrics could be added to achieve diagnostically relevant predictions. Although modeling techniques such as these are still in their infancy, future models of DCM severity could greatly improve automated clinical diagnosis, communications with patients, and patient outcomes.

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Deep flexor sarcopenia as a predictor of poor functional outcome after anterior cervical discectomy in patients with myelopathy

Cited by 8 publications

References 42 publications

The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies

Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model

Spinal Cord Morphology in Degenerative Cervical Myelopathy Patients; Assessing Key Morphological Characteristics Using Machine Vision Tools

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